Citation Nr: 21024143 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 17-62 505A DATE: April 22, 2021 REMANDED Entitlement to a compensable rating for genital warts is remanded. Service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from February 2000 to January 2003. He also served on active duty in the U.S. Army from February 2006 to June 2006, and from December 2007 to January 2009. In April 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In May 2020, the Veteran was provided a notice letter concerning a hearing scheduled for August 2020. The May 2020 letter and scheduling of a hearing was administrative error given that the Veteran was already provided a hearing in April 2020. In September 2020, the Veteran’s attorney confirmed that the Veteran did not want another hearing. Accordingly, the Board will proceed. 1. Entitlement to a compensable rating for genital warts is remanded. The Veteran’s genital warts are evaluated under Diagnostic Code 7806 by way of Diagnostic Code 7813. VA amended the criteria for rating skin disabilities effective from August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018); 83 Fed. Reg. 38,663 (Aug. 7, 2018). These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria are more favorable to the Veteran will be applied. 83 Fed. Reg. at 32,593. The Veteran’s claim was filed prior to August 13, 2018, and must be considered under both old and new rating criteria. The Board observes that under both the current and prior rating criteria, Diagnostic Code 7806 provides two potential avenues for evaluating a skin disability, the percentage of the body (or exposed areas) affected and the frequency of use of systemic therapy. However, the term “systemic therapy” is only defined under the current regulations. For claims filed prior to August 13, 2018, the U.S. Court of Appeals for Veterans Claims (Court) held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue and that the Board must determine (1) whether a treatment affects the body as a whole in treating a veteran’s skin condition; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug. Burton v. Wilkie, 30 Vet. App. 286 (2018). Here, the Veteran was last afforded a VA skin examination in 2015. Though the examination report indicated that there had been no use of any oral medication during the past year, the VA medical treatment records dated after that examination show recurrences of genital warts and the use of oral medication, Acyclovir, with a discussion of side effects. In light of the Court’s holding in Burton, the Board finds a medical opinion is necessary to determine whether the Veteran’s use of oral medication (1) operates by affecting the body as a whole and (2) is “like” a corticosteroid or other immunosuppressive drug. 2. Service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is remanded. The Veteran was most recently provided a VA psychiatric examination in July 2015. The examiner found that the Veteran did not have a diagnosis of PTSD. The examiner explained that the Veteran’s psychiatric disorder was best diagnosed as bipolar I with schizotypal and antisocial personality features. The examiner did not provide an opinion as to etiology. Recent VA medical treatment records reflect diagnoses of PTSD, anxiety disorder, and personality disorder. Service treatment records show that the Veteran was seen for behavioral problems in 2000 during service, evaluated in December 2008 for family stressors, and, in March 2009, the Veteran identified symptoms of increased irritability, feeling constantly on guard, watchful or easily startled, and feeling numb or detached from others. Given the above, the Board finds that the Veteran should be provided a new VA examination with an etiology opinion. 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4). In addition, the record reflects that the Veteran has received medical treatment at Cheer Counseling and the Tampa Vet Center. The Veteran should be provided another opportunity to identify relevant private records and submit appropriate releases or to submit those records himself. Further, the Veteran has provided several stressor statements, but has also identified a hazing incident when he was stomped on, during his hearing. The Veteran should be provided a new letter concerning stressors based on personal assault and asked to identify his in-service stressors. Finally, the Veteran indicated during his hearing that he was working on a claim for Social Security Administration (SSA) disability benefits. Thus, a request must be made for relevant SSA records. The matters are REMANDED for the following action: 1. Request updated VA treatment records, including complete hospitalization records from November and December 2019. 2. Contact the Veteran and request preleases for any private care providers who treated him. The Board is particularly interested in any records from Cheer Counseling and the Tampa Vet Center. Upon receipt of such, VA must take appropriate action to contact the identified providers and request complete treatment records. The Veteran should be informed that in the alternative he may obtain and submit the records himself. 3. Send the Veteran a letter concerning stressors based on personal assault and ask the Veteran to identify all reported in-service stressors. 4. Request all relevant SSA records with respect to the Veteran’s claims. 5. Schedule the Veteran for a VA skin examination for his genital warts. The RO should make efforts to schedule that examination during a flare-up. The claims folder must be made available for review. The report must note all manifestations of the Veteran’s disability. If the examination is not completed during a flare-up, the examiner should address the manifestations and symptoms during a flare-up. The examiner must also discuss all of the medications used for the Veteran’s service-connected skin disability, to include Acyclovir, and state whether any medication (1) operates by affecting the body as a whole in treating his skin condition and (2) is “like” a corticosteroid or other immunosuppressive drug. A full and complete rationale must be provided for any opinion reached. 6. Schedule the Veteran for a VA psychiatric examination for his claimed acquired psychiatric disorder, to include PTSD. The claims folder must be made available for review. The examiner must address the Veteran’s reported in-service stressors, to include those described during combat, and whether the Veteran has a diagnosis of PTSD. In doing so, the examiner must address the VA treatment records that show diagnoses of PTSD. If a diagnosis of PTSD is provided, the examiner must provide an opinion as to whether PTSD is at least as likely as not (50 percent probability or higher) caused or aggravated by active service. Concerning any other diagnosed psychiatric disability, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that any psychiatric disability diagnosed during the appeal period is caused or aggravated by active service. The examiner must also opine whether it is at least as likely as not (50 percent probability or higher) that any psychiatric disability superimposed on a personality disorder resulting in additional disability. A full and complete rationale must be provided for any opinion reached. 7. After taking any additional development deemed necessary, readjudicate the issues on appeal. If the benefit sought remain denied, issue a supplemental statement of the case and return the matters to the Board, if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Seay, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.